By Dr. John Kestle
The annual meeting of the AANS/CNS Section on Pediatric Neurological Surgery was held in Toronto Dec 3-6, 2013. HCRN was well represented with 3 papers presented in the hydrocephalus session. Dr. Jay Wellons presented the results of his prospective study on a standardized protocol for decision making in premature children with IVH (1). This study was performed over the last few years in response to a prior HCRN study. That prior study suggested that reservoirs were better than subgaleal shunts in these children but that treatment varied significantly from one center to another. The current study followed standard rubrics for decision making in these children and showed that standard decision making removed the center bias and resulted in a more accurate picture – the two procedures appear to be the same.
Dr. Ab Kulkarni presented the HCRN experience with ETV/CPC – 36 infants in the network were treated this way (2). The study was very preliminary but it appears that the procedure has reasonable safety and efficacy in selected cases.The degree of CPC achieved might be associated with a surgeon learning curve and appears to affect success, suggesting that surgeon training might improve results.
Dr. Tamara Simon’s work on risk factors for shunt infection (3) was presented by Dr. Jay Riva-Cambrin. The main finding was that shunt revision is the biggest risk factor for shunt infection. This emphasizes the need to reduce shunt revision rates.
Dr. Riva-Cambrin presented work on the “July effect” (4). In other words, are there more complications from shunt surgery in the summer when new residents join the service. This analysis was based on the HCRN database and had large numbers allowing adjustment for many factors. Fortunately, the answer was no – involvement of trainees in the summer (when they are starting ) did not increase the complication rates. This demonstrates that they receive appropriate mentoring.
(1) Shunting Outcomes in Post-Hemorrhagic Hydrocephalus (SOPHH): results of a Hydrocephalus Clinical Research Network (HCRN) prospective cohort study. John C. Wellons III, MD, MSPH; Chevis Shannon, MPH, MBA, DrPH; Jay Riva-Cambrin, MD, MSC; Abhaya Kulkarni, MD, PhD; David Limbrick, MD, PhD; William Whitehead, MD, MPH; Samuel Browd, MD, PhD; Jerry Oakes, MD; Curtis Rozzelle, MD; Tamara Simon, MD, MPH; Mandeep Tamber, MD, PhD; John Kestle, MD, MSC. American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Pediatric Neurological Surgery, Toronto Dec 4, 2013.
(2) Endoscopic Third Ventriculostomy (ETV) with Choroid Plexus Cauterization (CPC) in Infants with Hydrocephalus: a Retrospective Hydrocephalus Clinical Research Network (HCRN) Study. Abhaya Vivek Kulkarni, MD, FRCS; Jay Riva-Cambrin, MD, MSC; Samuel Browd, MD, PhD; James Drake, MD; Richard Holubkov, PhD; John Kestle, MD, MSC; David Limbrick, MD, PhD; Curtis Rozzelle, MD; Tamara Simon, MD; Mandeep Tamber, MD, PhD; John Wellons, MD, MSPH; William Whitehead, MD, MSC. American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Pediatric Neurological Surgery, Toronto, Dec 4, 2012.
(3) Risk Factors for First Cerebrospinal Fluid (CSF) Shunt Infection: Findings from HCRN’s Multi-center Prospective Cohort Study Jay Riva-Cambrin, MD, MSC; Tamara D. Simon, MD, MPH; Jerry Butler, MS; Kathryn Whitlock, MS; Samuel Browd, MD, PhD; Richard Holubkov, PhD; John Kestle, MD, MSC; Abhaya Kulkarni, MD, PhD; Marcie Langley, BS; David Limbrick, MD, PhD; Nicole Mayer-Hamblett, PhD; Mandeep Tamber, MD, PhD; John Wellons III, MD, MS; William Whitehead, MD, MPH (Seattle, WA)
(4) Is there a ‘July Effect’ Affecting Shunt Survival? Revisiting this Issue Using Prospectively Collected Data from the HCRN’s Shunt Registry. Jay K. Riva-Cambrin, MD, FAANS; John Kestle, MD; Sam Browd; William Whitehead; Richard Holubkov; James Drake; David Limbrick; Mandeep Tamber; Cutis Rozelle; Tamara Simon; John Wellons III; Abhaya Kulkarni (Salt Lake City, UT)